tbuckley/cabot-search huggingface dataset:
Abstract 12898: Mobile Health Interventions and Remote Blood Pressure Monitoring in Underserved Populations: A Systematic Review and Meta-Analysis
Authors: Miriam Katz, Reed Mszar, Alyssa A Grimshaw, Erica S Spatz
Journal: Circulation (2022)

Introduction: Disparities in blood pressure (BP) control persist in underserved communities. Although mobile health (mHealth) technologies have increased access to routine care for HTN, few studies have analyzed the effectiveness of mHealth interventions in populations experiencing HTN disparities. Methods: We conducted a systematic review of studies in seven databases published up to November 2021. The search used controlled vocabulary and keywords for HTN, mHealth interventions, and social determinants of health. We included papers that focused on mHealth interventions to manage HTN in underserved populations based on racial, ethnic, and socioeconomic factors. The primary outcome was change in systolic BP (SBP) and diastolic BP (DBP), and we assessed variations in the primary outcome by each study’s relative sociodemographic representation. Results: Among 2,644 unique studies identified, 24 studies (evaluating 7,960 participants in total) met our inclusion criteria. Demographic characteristics were similar between intervention and control groups (intervention: mean age 57.7 [SD 6.2] years; 59.8% women; 40.4% Black; 22.2% Hispanic). Among 18 studies that reported 6-month BP changes, reductions in SBP and DBP values in the intervention group were -7.03 mmHg (control: -2.71 mmHg) and -3.65 mmHg (control: -1.63 mmHg), respectively. Subgroup analysis showed that studies with a higher representation of Hispanic, low-income, and low-education level participants had less pronounced BP improvements than studies with a lower representation of these subgroups. Conclusion: This review provides evidence for the effectiveness of mHealth interventions for HTN management. Future studies and community-based initiatives are needed to further increase individuals’ access to these interventions and to ensure their effectiveness across all populations disproportionately impacted by HTN.
Abstract 13220: Real-World Analysis of the Electrical Performance and Projected Longevity of Leadless Ventricular Pacemakers
Authors: Mikhael F El-Chami, Rand Ibrahim, Kurt Stromberg, Dedra H Fagan, Jonathan P Piccini
Journal: Circulation (2022)

Introduction: The Micra™ VR leadless pacemaker has demonstrated a high implant success rate and a low rate of complications in both investigational and real-world settings. Although the manufacturer’s product performance reporting suggests a high device survival rate, projected longevity based upon real-world usage has not been assessed. Objective: To summarize device electricals and battery longevity in Micra VR leadless pacemakers in nationwide practice. Methods: A retrospective analysis was performed using Micra VR remote transmissions from the CareLink de-identified database queried on 1 June 2022. A patient’s last transmission ≥ 30 days post-implant was used for analysis. Pacing percentage, electrical performance, and battery longevity were summarized. To standardize the analysis, projected battery longevity was computed by adding the number of years between implant and the device’s last transmission and the projected battery life remaining at last transmission based on device use conditions. Results: Transmissions from 26,698 patients qualified for analysis. Median time from implant to final transmission was 19.8 months (range 1-96.7). Mean pacing capture threshold (PCT) was 0.61 ± 0.50 V (standardized to 0.24 ms) with 92.1% of patients having a PCT ≤1.0 V. Mean pacing impedance and sensing amplitude were 567 ± 118 ohms and 13.7 ± 6.3 mV. Median pacing percentage was 82.3% (IQR: 25.7% - 98.6%) with 43.9% of patients paced &gt;90%. Median projected battery longevity for the overall cohort was 13.7 years (IQR: 12.4 - 15.3 years) with 91.9% of devices exceeding 10 years (Figure). Among patients with &gt;90% pacing burden (N=11,717), median projected battery longevity was 12.6 years (IQR: 11.6-13.4) with 87.2% of devices exceeding 10 years. Conclusions: Real-world performance of the Micra VR leadless pacemaker demonstrates favorable pacing parameters with 92.1% of patients having pacing thresholds of ≤1.0 V and a median projected battery longevity of 13.7 years.
Abstract 13564: Novel Electrocardiogram Generating Technique Using Artificial Intelligence: From 2-lead to 12-lead
Authors: Hak Seung Lee, Yong-Yeon Jo, Sora Kang, Jong-Hwan Jang, Jeong Min Son, Min Sung Lee, Joon-Myoung Kwon
Journal: Circulation (2022)

Introduction: Based on the development of AI (artificial intelligence) and big data, an emerging number of methods achieved outstanding performance in myocardial infarction (MI) diagnosis by an electrocardiogram (ECG). However, conventional interpretation methods have low reliability for detecting MI and are challenging to apply to 2 leads of wearable devices. Objectives: To evaluate whether the novel method can facilitate MI diagnosis by only 2-lead ECG. Methods: We propose T2T (from 2-lead to 12-lead), a deep generative model that simulates a standard 12-lead ECG from an input of two asynchronous leads by generating ten leads. ( Figure a ) We used and selected 15,012 ECGs (9,527 normal, 5,485 samples with any MI) from the Physikalisch-Technische Bundesanstalt dataset. This dataset was split into stratified training, validation, and test sets with a ratio of 7:1:2. Three models using 2-lead, T2T, and 12-lead ECG were developed and validated to predict a diagnosis of MI, and their accuracy was compared. Results: The area under the receiver operating characteristic curves of the 2-lead, T2T and 12-lead ECG were 0.937, 0.948, and 0.960, respectively. Figure b shows representative cases over a two-second window, where the green and pink lines are the signals from the original ECG and T2T. The generated signals have less noise (seen in aVR and aVL in 2a and V4, V5, and V6) and baseline wander. For the V1 and V5 leads generated by T2T, the differences in amplitude are 6.4% and 7.3%, respectively, and the missing positional errors are under 10 ms. Conclusions: Novel ECG T2T algorithm demonstrated favorable performance in detecting MI using 12-lead ECG. Figure a. ECGT2T model architecture. The model is comprised of style, mapping, generative, and discriminative networks. Each network is built with residual blocks. Figure b. Representative samples of ECG T2T. The green line denotes the original signal, while the pink line represents the signals generated by ECGT2T.
Abstract 137: Effect Of Chest Compression Release Velocity On Cerebral Perfusion Pressure In A Porcine Experimental Model Of Cardiac Arrest.
Authors: Hyouk Jae Lim, Kyoung Jun Song, Ki Jeong Hong, Ki Hong Kim, Hanna Yoon, Stephen Gyung Won LEE, Seul Ki Choi, Gyeongmin Lee, YongJoo Park, Wonpyo Hong, Kang bin Lee
Journal: Circulation (2022)

Background: Previous studies have shown that chest compression release velocity (CCRV) of over 400mm/s is associated with improved survival and favorable neurologic outcome after cardiac arrest. However, it is uncertain whether CCRV during CPR is related to cerebral perfusion pressure (CePP). The purpose of this study was to evaluate the association between CCRV and CePP in a porcine cardiac arrest model. Methods: After 6 minutes of untreated ventricular fibrillation, 2 cycles of basic life support (BLS) and 12 cycles of advanced cardiovascular life support (ACLS) were conducted. During ACLS phase, CCRV was accelerated from 250mm/s to 450mm/s by 50mm/s (accelerating group) or decelerated from 450mm/s to 250mm/s by 50mm/s (decelerating group). Both groups performed BLS with the self-set value of the mechanical CPR device (LUCAS 2 chest compression system, CCRV of 170mm/s). Twenty-four pigs were randomly assigned to each group. Macrovascular circulation (CePP) and microvascular circulation using laser doppler flowmetry presented as a fraction of the baseline flow (f-LDF) were measured. We excluded the last 2 cycles of ACLS phase from the analysis due to time-dependent deterioration effects of hemodynamic outcomes. Linear mixed model was used to measure the median difference in CePP and f-LDF according to CCRV. Results: A total of 24 pigs were analyzed. Decelerating group of CCRV of 400mm/s showed significantly higher CePP values compared to the group of 170mm/s. Effect of changes in CCRV on CePP, stratified by groups, are as follows (median, [95% confidence intervals]): 1. Accelerating group: CCRV of 170mm/s; reference, 250mm/s; -1.98 [-10.78 - 11.79] mmHg, 300mm/s; -1.88 [-11.15 - 12.55] mmHg, 350mm/s; -2.55 [-11.46 - 12.24], 400mm/s; -6.05 [-5.59 - 16.86], and 2. Decelerating group: CCRV of 170mm/s; reference, 250mm/s; 5.71 [-16.27 - 27.11] mmHg, 300mm/s; 6.01 [-16.28 - 27.90] mmHg, 350mm/s; 6.96 [6.36 - 47.70], 400mm/s; 26.96 [6.36 - 47.70]. However, there was no significant CCRV effects on f-LDF (Accelerating CCRV of 400mm/s; 1.54 [ -0.03 - 3.10] and decelerating CCRV of 400mm/s; -2 [-4.42 - 0.34]). Conclusion: In a VF cardiac arrest porcine study, CCRV of 400mm/s at early phase of CPR has positive effects on CePP.
Abstract 13692: Gender, Process of Care and Mortality in Heart Failure Patients in India: Findings From the National Heart Failure Registry India
Authors: Amit Malviya, Animesh Mishra, Sanjay Ganapathi, Ajay Bahl, ambuj roy, Jayesh Prajapati, C.N. Manjunath, rishi sethi, Santanu Guha, Santhosh Satheesh, Panniyamakal Jeemon, R.S. Dhaliwal, Meenakshi Sharma, HARIKRISHNAN Sivadasanpillai
Journal: Circulation (2022)

Introduction: HF mortality rate vary by gender in high income countries. Process of care is often associated with differences in HF mortality. Hypothesis: We hypothesized that, HF process of care is associated with differential mortality in men and women. Methods: National Heart Failure Registry is a nationwide registry . Data from 10851 consecutive acute decompensated heart failure patients (ESC2016) criteria was analysed. At baseline we examined sociodemographic characteristics, clinical features , disease etiology and co-morbid conditions of patients. We assessed both in-hospital and 90-day mortality. Results: The mean age of study population was 59.9 (SD=13.5). More than two third (69%) participants were men. Sixty-five percent (Women = 58.6%, Men =68.2%, p value = p&lt;0.001) and 13%( Women = 19.5%, Men =9.6%, p value = p&lt;0.001) of patients had HF with reduced ejection fraction and HF with preserved ejection fraction, respectively. In this study, 71.2%(Women =74.2 %, Men = 69.8%, p value = p&lt;0.001) of patients had New York Heart Association (NYHA) Class III or Class IV. In-hospital and 90-day mortality rate were 6.7%(Women = 7.6%, Men = 6.3%, p value = 0.010) and 14.2%(Women = 14.9%, Men = 13.9%, p value =0.160), respectively(Fig:1). Beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) were prescribed in 75.7% (Women=74.2%, Men=76.4%, p value = 0.015), 61.2% (Women=60.6%, Men=61.4%, p value = 0.405) and 64.7% (Women=66.4%, Men=64.0%, p value = 0.016), respectively. The study population had very low usage of devices like the automatic implantable cardioverter-defibrillator 0.9% (Women=0.4%, Men=1.1%, p value =p&lt;0.001), cardiac resynchronization therapy defibrillator 1.0% (Women=1.1%, Men=1.0%, p value =0.75). Conclusion: The HF process of care differences may partially explains the differences in mortality in men and women.
Abstract 13524: Rising Burden of Acute Cardiovascular and Cerebrovascular Events in Young Females (18-44 Years) With Cannabis Use Disorder
Authors: Harsh R Sura, Mounika Pusa, Aneri Patel, Aditi Bhanushali, Muhammad Saad Siddique, Sanjana Aggarwal, Marisha Rai Sharma, Haris Javed, RITIKA DHRUVE, Rupak Desai
Journal: Circulation (2022)

Background: With the increasing recreational use of Cannabis in the United States, there is limited data on the impact of Cannabis use on young females. Therefore, we aimed to assess the risk and outcomes of cardiovascular and cerebrovascular events in young females with Cannabis use disorder (CUD). Method: The National Inpatient Sample (2019) was assessed to identify young, female hospitalizations (age 18-44 years) with CUD using relevant ICD-10 codes. Baseline characteristics and comorbidities were compared between two cohorts, CUD + and CUD -. The primary outcome was acute cardiovascular and cerebrovascular events evaluated using a multivariable regression analysis adjusting for confounders. Result: Of 1,72,36,228 young female hospitalizations, 2% had CUD+ (n=340560). CUD+ arm consisted of younger (median age-34 vs 59), black patients (28.2vs15.5%) and had a higher rate of drug abuse (62.1% vs 3%), smoking (50.7% vs 12.4%) and alcohol abuse (13.9% vs 2.5%) when compared to CUD- cohort (p&lt;0.001). Despite a lower prevalence of comorbidities (p&lt;0.001) such as Hypertension, Diabetes, Hyperlipidaemia, Obesity, PVD, CKD, Prior MI, Prior PCI, Prior CABG, Prior Stroke, Prior VTE, CUD+ group showed higher odds of Type 1 MI (OR=1.11,95%CI-1.04-1.18,p=0.001), Dysrhythmia (OR=1.08,95%CI-1.05-1.11,p-&lt;0.001), however the CUD+ cohort had lower odds of Type 2 MI(OR=0.89,95%CI-0.83-0.96,p-0.003), Cardiogenic Shock (OR=0.78,95%CI-0.7-0.87,p&lt;0.001), Cardiac arrest including VF (OR=0.79,95%CI-0.72-0.87,p&lt;0.001), and Acute PE (OR=0.74,95%CI-0.68-0.8,p&lt;0.001) as compared to without CUD cohort. Conclusion: Despite having an overall lower CVD risk burden, the CUD+ female cohort had a higher risk of Type 1 MI and Dysrhythmia after controlling for other confounding risk factors and substance abuse. abuse.
Abstract 14235: Hepatocyte Tissue Plasminogen Activator Limits Very-Low-Density Lipoprotein Production via Inhibiting ApoB-Microsomal Transfer Protein Interaction and ApoB Lipidation
Authors: Wen Dai, heng zhang, Hayley Lund, George Kuriakose, Ziyu Zhang, Maya Rodriguez, Jieqing Zhu, Mary Sorci Thomas, Roy Silverstein, Henry Ginsberg, Daisy Sahoo, Ira Tabas, Ze Zheng
Journal: Circulation (2022)

Lower plasma tissue plasminogen activator (tPA), a key fibrinolytic enzyme, is associated with higher atherogenic cholesterol levels in humans, but the mechanism is unknown. Hepatocyte (HC) is the factory producing atherogenic apoB lipoproteins, also a major source of basal plasma tPA. Our hypothesis is that tPA limits apoB-VLDL production in HCs.Silencing tPA in HCs using AAV8-H1-sh-tPA in Ldlr -/- mice leads to increased plasma cholesterol, triglyceride, apoB, and exacerbated atherosclerosis compared with scramble-silenced controls. Fractionation of plasma lipoproteins by FPLC or ultracentrifugation shows increased cholesterol and apoB in VLDL and LDL fractions. Inhibiting VLDL hydrolysis by P407 leads to a faster plasma triglyceride-rising rate in HC-tPA-silenced wild type mice, suggesting higher hepatic VLDL production. In a pulse-chase assay, tPA-silenced human primary HC has higher apoB-associated radioactivity in cell medium and lysate, suggesting increased apoB production.Adequate apoB lipidation is required for its secretion. By electronic microscopy, the distribution of VLDL shifts to a larger diameter in plasma VLDL isolated from HC-tPA-silenced Ldlr -/- mice, suggesting higher lipid contents in VLDL. The endoplasmic reticulum (ER)-associated apoB is higher in tPA-silenced vs. control HCs, more prominent in the less denser density fractions. As density and lipidation are inversely related, these findings are consistent with the hypothesis that tPA limits apoB lipidation in ER. MTP is an ER chaperone incorporating neutral lipids onto apoB in HC. The tPA-silenced human primary HC has higher neutral lipid transfer activity than controls, despite similar MTP protein levels. Moreover, higher apoB is in the anti-MTP-precipitations from tPA-silenced vs. control HCs, suggesting that silencing tPA increases apoB-MTP interaction. Proximity ligation and immunoprecipitation assays show tPA interacts with apoB in HC. Solid-phase binding assay and native gel reveal purified human tPA binds to LDL, but not to MTP. tPA competes with MTP in binding to LDL. Moreover, tPA inhibits MTP-mediated neutral lipid transfer. These findings suggested tPA binds to apoB and inhibits MTP-dependent apoB lipidation and VLDL secretion.
Abstract 13972: Intermittent Occlusion of the Superior Vena Cava Improves Urine Sodium Excretion in Patients With Acutely Decompensated Heart Failure
Authors: Jacob Abraham, Rayan Yousefzai, Michael S Kiernan, Ryan J Tedford, Keith Benzuly, Richard Karas, Daniel Burkhoff, Navin K Kapur
Journal: Circulation (2022)

BACKGROUND: Urine sodium excretion identifies risk for short and long-term adverse events in acutely decompensated heart failure (ADHF). The VENUS HF Early Feasibility Study is testing whether intermittent occlusion of the superior vena cava (SVC) with the preCARDIA system, a catheter mounted balloon and pump console, improves decongestion in ADHF. We hypothesized that preCARDIA therapy increases natriuresis in ADHF. Methods: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 32 patients with ADHF were assigned to preCARDIA therapy for 24 hours. Urine output and urine electrolytes were measured from a spot urine sample before, immediately after, and for 24 hours after preCARDIA treatment in 13 patients. Results: 32 patients were enrolled and received the preCARDIA system. Thirteen patients had complete urine electrolytes available for analysis. Compared to pre-treatment values, total daily urine output increased (1.9±0.8 vs. 4.2±1.5 L/day, p&lt;0.001) and net fluid balance improved (-1.2±0.8 vs. -2.6±1.4 L/day, p=0.01) with treatment. Compared to pre-treatment, urine sodium (U-Na: 64±26 vs 97±24 mEq/L, p=0.0008) and U-Na/urine creatinine (U-Na/U-Cr: 1.7±1.3 vs 5.3±3.9 mmol/mg p=0.024) increased with treatment (Figure). Improved daily urine output and net fluid balance persisted 24 hours after treatment (1.9±0.8 vs 4.4±1.5 L p=0.0001; -1.2±0.8 vs -3.2±1.5 L/24h p=0.0003, respectively). Both U-Na and U-Na/U-Cr remained increased 24 hours after device removal (90 mEq/L, p=0.01; 3.93±2.8 p=0.026). Treatment increased fractional excretion of U-Na (2.08±1.87% vs. 4.22±2.72% p=0.05). No change in potassium excretion was observed. Conclusions: We report for the first time that intermittent SVC occlusion using the preCARDIA system to reduce congestion may increase urinary sodium excretion in ADHF. Future studies will further test the clinical utility of the preCARDIA system.
Abstract 13596: Effects of Plasminogen Activator Inhibitor-1 on the Circadian Clock in Liver
Authors: Lisa D Wilsbacher, Joshua A Levine, Mesut Eren, Meng Shang, Anthony Kalousdian, Douglas E Vaughan
Journal: Circulation (2022)

Introduction: Plasminogen activator inhibitor-1 (PAI-1, encoded by Serpine1 ) plays a major role in the mammalian fibrinolytic system, but elevated PAI-1 activity contributes to other biological processes including the metabolic syndrome. Multiple studies suggest that disruption of circadian rhythms also promotes features of the metabolic syndrome including obesity, hypertension, and type 2 diabetes. While it has been long known that PAI-1 plasma levels exhibit a marked circadian variation, and that the expression of PAI-1 is strongly influenced by the clock, a reciprocal role for PAI-1 in regulating components of the clock itself has never been described. Hypothesis: We hypothesized that changes in PAI-1 activity influence the expression of core circadian clock genes and clock-controlled genes in the liver. Methods: We used two mouse models of reduced PAI-1 activity: oral PAI-1 inhibitor TM5614 (20 mg/kg/day) versus vehicle in C57BL/6J wild-type mice (n = 5 per group), and Serpine +/- heterozygous mice versus wild-type littermate control mice (n = 3 per group). Mice were maintained on a 14:10 light:dark cycle. Livers were collected between 3 and 4 hours after lights-on, which corresponds to Zeitgeber Time (ZT) 3-4. RNA was isolated for RNA-seq and downstream analyses. Results: Between ZT 3-4, we found that reduced PAI-1 activity led to marked changes in circadian gene expression in the liver. Both PAI-1 inhibition with TM5614 and PAI-1 haploinsufficiency significantly increased expression of the core circadian clock components Arntl (aka Bmal1) and Clock while significantly reducing expression of core clock components Per1, Per2, Per3, and clock output genes. Furthermore, we found that PAI-1 inhibition in aged transgenic mice overexpressing the stable variant of human SERPINE1 rescued two markers of impaired circadian function: 1) the premature onset of activity prior to lights-off, and 2) reduced feeding during the lights-off period. Conclusions: Taken together, these data support a reciprocal role for PAI-1 in regulating components of the circadian clock. Elevated PAI-1 activity may contribute to the metabolic syndrome through effects on the circadian clock and may provide a mechanistic link between PAI-1, the circadian clock, and aging.
Abstract 14191: Text Message Reminders Are Feasible in Haiti and May Increase Clinic Attendance for Non-Communicable Diseases: A Pilot Study
Authors: Sarah M Morris, Bolanle Banigbe, Evyrna Toussaint, Darius Léopold Fénelon, Calixte Dawson, Gene Kwan
Journal: Circulation (2022)

Introduction: Chronic non-communicable disease (NCD) care requires long-term compliance with clinic appointments. In rural Haiti, remembering appointments is a barrier to visit adherence. While short message service (SMS) text reminders can improve attendance in other settings, this has not been assessed Haiti. This quality improvement study assesses the feasibility and acceptability of using SMS reminders to promote clinic attendance in rural Haiti. Methods: We included patients at the NCD and type 1 diabetes clinics of Hôpital Universitaire de Mirebalais, Haiti. Patients with upcoming visits were sent 2 SMS reminders 3 days and 1 day before their visit. Patients who attended their clinic visit completed a survey regarding the feasibility, acceptability, and usefulness of the SMS reminders. The primary study outcome was the proportion of patients who received SMS messages. Secondary outcomes included the proportion of patients who found SMS reminders acceptable, missed clinic appointments, and could not be reached by phone. Results: Of the 96 patients with scheduled visits during the study period, we sent SMS reminders to 88 (91.2%) patients; 8 did not have recorded phone numbers. 25% of patients missed their visit and 9% were unable to be reached by phone. The 72 patients that attended their visit had a mean age of 49.5 years and 58.2% were female. Half of those who attended their visit (36) received the SMS. Of the 36 patients that received the SMS, 100% liked the reminder, 97.2% wanted to receive future messages, and 22.2% reported they would not have attended their visit without the reminder. Of the 36 patients who did not receive the SMS, 14 (38.9%) had a new phone number while 12 (33.3%) did not have access to a phone. The biggest patient-reported barriers to receiving SMS were inconsistent cellular signal (25%) and lack of access to a phone (22%). Conclusion: Sending SMS reminders was feasible and acceptable to NCD patients in rural Haiti. The messages were universally liked by the patients who received them and influenced the decision to attend their visit. For some patients, inconsistent signal and lack of phone access will need to be addressed. If implemented at full scale, SMS reminders could significantly improve appointment attendance in rural Haiti.